Why Your Oral Health Might Decline with Age

If you are one of our patients over 65, you are in good company. Per the 2020 census, more than 56 million people in the US are 65 and older, or almost 17% of the total population. By 2030, 73 million will be over 65, and 86 million by 2050.[i]

Like many of our older patients, you might wonder what oral health and age have to do with each other. It turns out that aging and oral health have more to do with each other than you probably think, but not for the reasons you might be thinking. 

This article explores geriatric dentistry, oral health, and aging. We will examine whether oral health declines with age, what contributes to that decline, the relationship between medication and oral health, the effect of oral health home care disruptions, and how to improve oral health for seniors.

Regarding age and oral health quality of life, we maintain that managing one's oral health is essential at any age, and no less so for our older patients. Moreover, often there are indications seniors or their caregivers do not manage their oral health to its best possible outcome. Consider the following statistics:

• 96% of older adults have had a cavity
• 20% of older adults have untreated tooth decay [ii]
• 68% of older adults have gum disease [iii] and are often diagnosed with severe cases[iv]
• 62 is the median age for diagnosis of oral cancer [v]

It might surprise you that age isn't the leading cause of the decline in oral health, although it is a contributing factor. Teeth that have been cared for through good oral healthcare habits and healthy lifestyle choices (plus a dose of good genetics) can be in excellent shape even in the most mature mouths. 

There are many reasons why oral health declines when people age, starting with how often patients go to the dentist. Many patients in this age group go to the dentist, but less and less the older they get. 

If you consider the entire group of patients over 65 years of age, 66% had been to see their dentist in the past year. Further, if you segment the group at 74 and younger, that number rises to 68%. However, the rate drops to 64% for patients between 75 and 84 and decreases to 58% for patients over 85. [vi]  

Experts think this decline has many reasons, from age-related causes to financial contributors to societal factors. For example, adults in this age group can't always get to dental appointments. Many older adults quit driving as they age or live in nursing homes, so they depend on caregivers to get to the dentist.[vii] Plus, fewer adults in this age group have dental coverage, and Medicare does not cover most of the regular dental care these patients need.[viii]

Mature patients also have complicated health histories. Seniors have a higher rate of obesity (29.3%) than previous generations. Often, inflammatory conditions like cardiovascular disease, diabetes, and Alzheimer's disease have settled in, too, requiring medications to manage them. In the 65 to 74 age range, 46% had multiple chronic conditions. [ix]

The prescription medications for these conditions can lead to complications with oral health, and this age group is taking them. Per the ADA, the average older patient takes four or five prescription medications along with two or three over-the-counter medications. [x]

One common side effect of taking medications for conditions that affect this age group is Xerostomia, or dry mouth. Dry mouth and aging have a lot to do with oral health. When the oral environment produces less saliva, there are higher decay rates, both on the teeth and on exposed root surfaces, resulting from gum recession. It can also result in mucositis, tongue fissures, and cracked lips. [xi]

Moreover, in addition to a prevalence of gum disease, older adults have high rates of candidiasis, or thrush, which is a fungal infection that causes a buildup of white patches in the oral cavity, redness and soreness, loss of taste and other symptoms in the mouth and throat. [xii]

In addition, all the patients' dental decisions from the past might also affect their oral health as they age. For example, these patients might experience: [xiii]

• Darkened or yellow-looking teeth from consuming foods and drinks that stain the dentin over the years, which becomes more noticeable as the enamel thins, allowing the staining to show through
• Shifting teeth next to missing teeth that they chose not to replace, which affects their bite and results in wear on the jaw bone and temporomandibular joint disorders (TMJ) 
• Stomatitis, is a condition that inflames the oral tissues, from wearing a removable denture that doesn't fit right or that they don't clean enough

Other systemic illnesses and psychological changes in aging affect oral health, too. For example, some conditions might prevent them from taking care of themselves and their home care, which only exacerbates the problems with oral health. 

Many patients in this age group have physical, sensory, or cognitive losses that can make regular oral healthcare maintenance difficult. [xiv] For example, arthritis in the hands and fingers might make it difficult or impossible to brush or floss. [xv] In other cases, some patients experiencing progressions of dementia or Alzheimer's disease might be unable to take care of their teeth, either because they stop understanding that it is essential or because they don't care about it. [xvi]

Social influences are also at work here. Women are more likely than men to see a dentist and retain their natural dentition. The more educated patients have also influenced their probability of having better oral health than those without formal education. In addition, some older patients that lack a support system resulting from separation, divorce, or death of a spouse may become isolated and are more likely to have poor oral health than those who have people around. [xvii]

The key to improving oral healthcare for senior patients isn't complicated. It requires diligent brushing and flossing daily to keep plaque in check. 

Without regular home care, plaque builds up on teeth and any exposed root surfaces, which leads to tooth decay and gum disease. Therefore, older patients (and patients of any age) should maintain a home care routine that includes:[xviii]

• Brushing at least twice daily for at least two minutes using fluoride toothpaste
• Flossing at least once a day
• Rinsing with an antiseptic mouthwash once or twice a day

In addition, senior patients should visit their dental team regularly. At the exam, the dental team can perform an oral exam and clean teeth. [xix] The ADA also recommends the regular topical application of fluoride at these visits to help protect against decay. [xx] For patients that have gum disease in its early or later stages can also begin treatment for those areas of inflammation, halting the progress of the disease and improving their oral health. 

In addition to treating gum disease, dental professionals can address other oral health issues older patients often face. For example, tooth loss is a common problem for this age group. However, some treatments can replace missing teeth to restore function and improve the patient's smile. Some treatments can even protect against bone loss. 

Dental implants are permanent replacement teeth affixed to a metal implant surgically placed in the jaw. This solution is the most like your natural teeth. [xxi] Plus, a dental implant feels like a natural tooth and doesn't require changing the surrounding teeth, as a dental bridge does. Plus, it protects against bone loss in the jaw. [xxii]

Another option for replacing missing teeth is dentures. Dentures can be for part of your teeth or all of them, depending upon your needs. Dentures are removable appliances that look like your natural teeth and gums. However, they are not permanent; patients wear them all day and then take them out at night. [xxiii]

Many of our older patients no longer have dental insurance, and Medicare does not cover their dental care. However, there are options for our patients of any age that need help paying for dental treatment with no insurance. For example, our Smile Generation Dental Plan® is a dental savings plan with pre-negotiated discounts built into its membership. In other words, if you are a member, your treatment rates at a Smile Generation dental practice are lower than those for non-members. 

Here are some other key benefits of our Smile Generation Dental Plan:

• There is no waiting period, unlike many dental insurance policies
• Patients with pre-existing conditions cannot be denied coverage
• There are no annual maximums or deductibles

Still, have questions about seniors and dental care? Don't hesitate to contact us to find a Smile Generation dentist near you to schedule an appointment for yourself or someone you love. Not only can you get your questions answered about oral healthcare for older adults, but your Smile Generation team can recommend what they think will help provide the best possible outcome for their oral health treatment. Use our Find a Dentist tool to find a dentist near you.